Diabetes Standards of Care and Resources for Clinicians and Educators
Foot Care
People who have diabetes are at high risk for nerve and vascular damage that can result in loss of protective sensation in the feet, reduced circulation, and poor healing. Foot ulcers and amputations, due to diabetic neuropathy and/or peripheral arterial disease (PAD), are common and preventable causes of disability in adults with diabetes. Since many patients with diabetes who present for routine care will have a condition that requires attention (e.g., calluses, bacterial or fungal infections, bulky or ingrown nails, or frank ulceration), it is important to inspect patients' feet at every diabetes visit.
Obtain a history of ulceration, amputation, Charcot foot, angioplasty or vascular surgery, cigarette smoking, retinopathy, renal disease, vascular disease, and assess symptoms of neuropathy (pain, burning, numbness, tingling) and vascular disease (leg fatigue, claudication [leg pain], skin changes, weak or absent pulses).
At each diabetes visit, inspect patients' feet for acute problems
At diabetes diagnosis, and at least annually, perform a comprehensive foot examination to include an assessment of:
Skin integrity
Hair growth
Vascular status including pulses in the legs and feet
Foot structure and biomechanics
Neurological exam with a 10-g monofilament and at least one other assessment (vibration sensation using a 128-Hz tuning fork, pinprick sensation, or ankle reflexes)
After completing a comprehensive foot exam, assign a risk category for each patient. Risk categories are defined as:
Low Risk: normal sensory exams, foot structure, vascular status, and skin integrity, and no prior non-traumatic ulcerations
High Risk: abnormalities on exam or a history of non-traumatic ulcerations
Provide risk-appropriate evaluation and monitoring, and refer patients as needed to foot care specialists (podiatrists, wound care specialists), footwear providers, orthopedists, and vascular surgeons.
Provide self-management education including proper care of the feet, nails and skin, appropriate footwear, and daily visual inspection of the feet.
Monofilaments are available to Federal, Tribal, and Urban clinics and programs treating American Indian and Alaska Native people. (Available in packages of 20 monofilaments – order limit is 5 packages.)
